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Li X, Fernandes BS, Liu A, Chen J, Chen X, Zhao Z, Dai Y. GRPa-PRS: A risk stratification method to identify genetically-regulated pathways in polygenic diseases. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.06.19.23291621. [PMID: 37425929 PMCID: PMC10327215 DOI: 10.1101/2023.06.19.23291621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background Polygenic risk scores (PRS) are tools used to evaluate an individual's susceptibility to polygenic diseases based on their genetic profile. A considerable proportion of people carry a high genetic risk but evade the disease. On the other hand, some individuals with a low risk of eventually developing the disease. We hypothesized that unknown counterfactors might be involved in reversing the PRS prediction, which might provide new insights into the pathogenesis, prevention, and early intervention of diseases. Methods We built a novel computational framework to identify genetically-regulated pathways (GRPas) using PRS-based stratification for each cohort. We curated two AD cohorts with genotyping data; the discovery (disc) and the replication (rep) datasets include 2722 and 2854 individuals, respectively. First, we calculated the optimized PRS model based on the three recent AD GWAS summary statistics for each cohort. Then, we stratified the individuals by their PRS and clinical diagnosis into six biologically meaningful PRS strata, such as AD cases with low/high risk and cognitively normal (CN) with low/high risk. Lastly, we imputed individual genetically-regulated expression (GReX) and identified differential GReX and GRPas between risk strata using gene-set enrichment and variational analyses in two models, with and without APOE effects. An orthogonality test was further conducted to verify those GRPas are independent of PRS risk. To verify the generalizability of other polygenic diseases, we further applied a default model of GRPa-PRS for schizophrenia (SCZ). Results For each stratum, we conducted the same procedures in both the disc and rep datasets for comparison. In AD, we identified several well-known AD-related pathways, including amyloid-beta clearance, tau protein binding, and astrocyte response to oxidative stress. Additionally, we discovered resilience-related GRPs that are orthogonal to AD PRS, such as the calcium signaling pathway and divalent inorganic cation homeostasis. In SCZ, pathways related to mitochondrial function and muscle development were highlighted. Finally, our GRPa-PRS method identified more consistent differential pathways compared to another variant-based pathway PRS method. Conclusions We developed a framework, GRPa-PRS, to systematically explore the differential GReX and GRPas among individuals stratified by their estimated PRS. The GReX-level comparison among those strata unveiled new insights into the pathways associated with disease risk and resilience. Our framework is extendable to other polygenic complex diseases.
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Affiliation(s)
- Xiaoyang Li
- Center for Precision Health, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Brisa S. Fernandes
- Center for Precision Health, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Andi Liu
- Center for Precision Health, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Jingchun Chen
- Nevada Institute of Personalized Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
| | - Xiangning Chen
- Center for Precision Health, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Zhongming Zhao
- Center for Precision Health, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Yulin Dai
- Center for Precision Health, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Liu L, Sun S, Kang W, Wu S, Lin L. A review of neuroimaging-based data-driven approach for Alzheimer's disease heterogeneity analysis. Rev Neurosci 2024; 35:121-139. [PMID: 37419866 DOI: 10.1515/revneuro-2023-0033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/18/2023] [Indexed: 07/09/2023]
Abstract
Alzheimer's disease (AD) is a complex form of dementia and due to its high phenotypic variability, its diagnosis and monitoring can be quite challenging. Biomarkers play a crucial role in AD diagnosis and monitoring, but interpreting these biomarkers can be problematic due to their spatial and temporal heterogeneity. Therefore, researchers are increasingly turning to imaging-based biomarkers that employ data-driven computational approaches to examine the heterogeneity of AD. In this comprehensive review article, we aim to provide health professionals with a comprehensive view of past applications of data-driven computational approaches in studying AD heterogeneity and planning future research directions. We first define and offer basic insights into different categories of heterogeneity analysis, including spatial heterogeneity, temporal heterogeneity, and spatial-temporal heterogeneity. Then, we scrutinize 22 articles relating to spatial heterogeneity, 14 articles relating to temporal heterogeneity, and five articles relating to spatial-temporal heterogeneity, highlighting the strengths and limitations of these strategies. Furthermore, we discuss the importance of understanding spatial heterogeneity in AD subtypes and their clinical manifestations, biomarkers for abnormal orderings and AD stages, the recent advancements in spatial-temporal heterogeneity analysis for AD, and the emerging role of omics data integration in advancing personalized diagnosis and treatment for AD patients. By emphasizing the significance of understanding AD heterogeneity, we hope to stimulate further research in this field to facilitate the development of personalized interventions for AD patients.
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Affiliation(s)
- Lingyu Liu
- Intelligent Physiological Measurement and Clinical Translation, Beijing International Platform for Scientific and Technological Cooperation, Department of Biomedical Engineering, Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing, 100124, China
| | - Shen Sun
- Intelligent Physiological Measurement and Clinical Translation, Beijing International Platform for Scientific and Technological Cooperation, Department of Biomedical Engineering, Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing, 100124, China
| | - Wenjie Kang
- Intelligent Physiological Measurement and Clinical Translation, Beijing International Platform for Scientific and Technological Cooperation, Department of Biomedical Engineering, Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing, 100124, China
| | - Shuicai Wu
- Intelligent Physiological Measurement and Clinical Translation, Beijing International Platform for Scientific and Technological Cooperation, Department of Biomedical Engineering, Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing, 100124, China
| | - Lan Lin
- Intelligent Physiological Measurement and Clinical Translation, Beijing International Platform for Scientific and Technological Cooperation, Department of Biomedical Engineering, Faculty of Environment and Life Sciences, Beijing University of Technology, Beijing, 100124, China
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Wei Z, Chenjun W, Feiyang X, Mingfeng J, Yixuan Z, Qi L, Zhuoxing S, Qi D. scHybridBERT: integrating gene regulation and cell graph for spatiotemporal dynamics in single-cell clustering. Brief Bioinform 2024; 25:bbae018. [PMID: 38517692 PMCID: PMC10959234 DOI: 10.1093/bib/bbae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 03/24/2024] Open
Abstract
Graph learning models have received increasing attention in the computational analysis of single-cell RNA sequencing (scRNA-seq) data. Compared with conventional deep neural networks, graph neural networks and language models have exhibited superior performance by extracting graph-structured data from raw gene count matrices. Established deep neural network-based clustering approaches generally focus on temporal expression patterns while ignoring inherent interactions at gene-level as well as cell-level, which could be regarded as spatial dynamics in single-cell data. Both gene-gene and cell-cell interactions are able to boost the performance of cell type detection, under the framework of multi-view modeling. In this study, spatiotemporal embedding and cell graphs are extracted to capture spatial dynamics at the molecular level. In order to enhance the accuracy of cell type detection, this study proposes the scHybridBERT architecture to conduct multi-view modeling of scRNA-seq data using extracted spatiotemporal patterns. In this scHybridBERT method, graph learning models are employed to deal with cell graphs and the Performer model employs spatiotemporal embeddings. Experimental outcomes about benchmark scRNA-seq datasets indicate that the proposed scHybridBERT method is able to enhance the accuracy of single-cell clustering tasks by integrating spatiotemporal embeddings and cell graphs.
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Affiliation(s)
- Zhang Wei
- Zhejiang Sci-Tech University, 310028, Hangzhou, China
| | - Wu Chenjun
- Zhejiang Sci-Tech University, 310028, Hangzhou, China
| | - Xing Feiyang
- Translational Medical Center for Stem Cell Therapy and Institute for Regenerative Medicine, Shanghai East Hospital, Frontier Science Center for Stem Cell Research, Bioinformatics Department, School of Life Sciences and Technology, Tongji University, 200092, Shanghai, China
| | | | - Zhang Yixuan
- Zhejiang Sci-Tech University, 310028, Hangzhou, China
| | - Liu Qi
- Translational Medical Center for Stem Cell Therapy and Institute for Regenerative Medicine, Shanghai East Hospital, Frontier Science Center for Stem Cell Research, Bioinformatics Department, School of Life Sciences and Technology, Tongji University, 200092, Shanghai, China
| | - Shi Zhuoxing
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, 510060, Guangzhou, China
| | - Dai Qi
- Zhejiang Sci-Tech University, 310028, Hangzhou, China
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Bettencourt C, Skene N, Bandres-Ciga S, Anderson E, Winchester LM, Foote IF, Schwartzentruber J, Botia JA, Nalls M, Singleton A, Schilder BM, Humphrey J, Marzi SJ, Toomey CE, Kleifat AA, Harshfield EL, Garfield V, Sandor C, Keat S, Tamburin S, Frigerio CS, Lourida I, Ranson JM, Llewellyn DJ. Artificial intelligence for dementia genetics and omics. Alzheimers Dement 2023; 19:5905-5921. [PMID: 37606627 PMCID: PMC10841325 DOI: 10.1002/alz.13427] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023]
Abstract
Genetics and omics studies of Alzheimer's disease and other dementia subtypes enhance our understanding of underlying mechanisms and pathways that can be targeted. We identified key remaining challenges: First, can we enhance genetic studies to address missing heritability? Can we identify reproducible omics signatures that differentiate between dementia subtypes? Can high-dimensional omics data identify improved biomarkers? How can genetics inform our understanding of causal status of dementia risk factors? And which biological processes are altered by dementia-related genetic variation? Artificial intelligence (AI) and machine learning approaches give us powerful new tools in helping us to tackle these challenges, and we review possible solutions and examples of best practice. However, their limitations also need to be considered, as well as the need for coordinated multidisciplinary research and diverse deeply phenotyped cohorts. Ultimately AI approaches improve our ability to interrogate genetics and omics data for precision dementia medicine. HIGHLIGHTS: We have identified five key challenges in dementia genetics and omics studies. AI can enable detection of undiscovered patterns in dementia genetics and omics data. Enhanced and more diverse genetics and omics datasets are still needed. Multidisciplinary collaborative efforts using AI can boost dementia research.
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Affiliation(s)
- Conceicao Bettencourt
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Nathan Skene
- UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Sara Bandres-Ciga
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Emma Anderson
- Department of Mental Health of Older People, Division of Psychiatry, University College London, London, UK
| | | | - Isabelle F Foote
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado, USA
| | - Jeremy Schwartzentruber
- Open Targets, Cambridge, UK
- Wellcome Sanger Institute, Cambridge, UK
- Illumina Artificial Intelligence Laboratory, Illumina Inc, Foster City, California, USA
| | - Juan A Botia
- Departamento de Ingeniería de la Información y las Comunicaciones, Universidad de Murcia, Murcia, Spain
| | - Mike Nalls
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Data Tecnica International LLC, Washington, DC, USA
| | - Andrew Singleton
- Center for Alzheimer's and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Brian M Schilder
- UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Jack Humphrey
- Nash Family Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Sarah J Marzi
- UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Christina E Toomey
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK
- The Francis Crick Institute, London, UK
| | - Ahmad Al Kleifat
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eric L Harshfield
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Victoria Garfield
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - Cynthia Sandor
- UK Dementia Research Institute. School of Medicine, Cardiff University, Cardiff, UK
| | - Samuel Keat
- UK Dementia Research Institute. School of Medicine, Cardiff University, Cardiff, UK
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Section, University of Verona, Verona, Italy
| | - Carlo Sala Frigerio
- UK Dementia Research Institute, Queen Square Institute of Neurology, University College London, London, UK
| | | | | | - David J Llewellyn
- University of Exeter Medical School, Exeter, UK
- The Alan Turing Institute, London, UK
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Fisher DW, Dunn JT, Keszycki R, Rodriguez G, Bennett DA, Wilson RS, Dong H. Unique Transcriptional Signatures Correlate with Behavioral and Psychological Symptom Domains in Alzheimer's Disease. RESEARCH SQUARE 2023:rs.3.rs-2444391. [PMID: 36711772 PMCID: PMC9882691 DOI: 10.21203/rs.3.rs-2444391/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite the significant burden, cost, and worse prognosis of Alzheimer's disease (AD) with behavioral and psychological symptoms of dementia (BPSD), little is known about the molecular causes of these symptoms. Using antemortem assessments of BPSD in AD, we demonstrate that individual BPSD can be grouped into 4 domain factors in our sample: affective, apathy, agitation, and psychosis. Then, we performed a transcriptome-wide analysis for each domain utilizing bulk RNA-seq of post-mortem anterior cingulate cortex (ACC) tissue. Though all 4 domains are associated with a predominantly downregulated pattern of hundreds of differentially expressed genes (DEGs), most DEGs are unique to each domain, with only 22 DEGs being common to all BPSD domains, including TIMP1. Weighted gene co-expression network analysis (WGCNA) yielded multiple transcriptional modules that were shared between BPSD domains or unique to each domain, and NetDecoder was used to analyze context-dependent information flow through the biological network. For the agitation domain, we found that all DEGs and a highly correlated transcriptional module were functionally enriched for ECM-related genes including TIMP1, TAGLN, and FLNA. Another unique transcriptional module also associated with the agitation domain was enriched with genes involved in post-synaptic signaling, including DRD1, PDE1B, CAMK4, and GABRA4. By comparing context-dependent changes in DEGs between cases and control networks, ESR1 and PARK2 were implicated as two high impact genes associated with agitation that mediated significant information flow through the biological network. Overall, our work establishes unique targets for future study of the biological mechanisms of BPSD and resultant drug development.
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Affiliation(s)
- Daniel W. Fisher
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
- Department of Psychiatry and Behavioral Sciences,
University of Washington School of Medicine
| | - Jeffrey T. Dunn
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
| | - Rachel Keszycki
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
- Mesulam Center for Cognitive Neurology and
Alzheimer’s Disease, Northwestern University Feinberg School of
Medicine
| | - Guadalupe Rodriguez
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
| | | | | | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine
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Saleem TJ, Zahra SR, Wu F, Alwakeel A, Alwakeel M, Jeribi F, Hijji M. Deep Learning-Based Diagnosis of Alzheimer's Disease. J Pers Med 2022; 12:815. [PMID: 35629237 PMCID: PMC9143671 DOI: 10.3390/jpm12050815] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 12/27/2022] Open
Abstract
Alzheimer's disease (AD), the most familiar type of dementia, is a severe concern in modern healthcare. Around 5.5 million people aged 65 and above have AD, and it is the sixth leading cause of mortality in the US. AD is an irreversible, degenerative brain disorder characterized by a loss of cognitive function and has no proven cure. Deep learning techniques have gained popularity in recent years, particularly in the domains of natural language processing and computer vision. Since 2014, these techniques have begun to achieve substantial consideration in AD diagnosis research, and the number of papers published in this arena is rising drastically. Deep learning techniques have been reported to be more accurate for AD diagnosis in comparison to conventional machine learning models. Motivated to explore the potential of deep learning in AD diagnosis, this study reviews the current state-of-the-art in AD diagnosis using deep learning. We summarize the most recent trends and findings using a thorough literature review. The study also explores the different biomarkers and datasets for AD diagnosis. Even though deep learning has shown promise in AD diagnosis, there are still several challenges that need to be addressed.
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Affiliation(s)
- Tausifa Jan Saleem
- Department of Computer Science and Engineering, National Institute of Technology Srinagar, Srinagar 190006, J&K, India; (T.J.S.); (S.R.Z.)
| | - Syed Rameem Zahra
- Department of Computer Science and Engineering, National Institute of Technology Srinagar, Srinagar 190006, J&K, India; (T.J.S.); (S.R.Z.)
| | - Fan Wu
- Department of Computer Science, Tuskegee University, Tuskegee, AL 36088, USA;
| | - Ahmed Alwakeel
- Sensor Network and Cellular Systems Research Center, University of Tabuk, Tabuk 71491, Saudi Arabia
- Faculty of Computers & Information Technology, University of Tabuk, Tabuk 71491, Saudi Arabia; (M.A.); (M.H.)
| | - Mohammed Alwakeel
- Faculty of Computers & Information Technology, University of Tabuk, Tabuk 71491, Saudi Arabia; (M.A.); (M.H.)
| | - Fathe Jeribi
- College of Computer Science and Information Technology, Jazan University, Jazan 45142, Saudi Arabia;
| | - Mohammad Hijji
- Faculty of Computers & Information Technology, University of Tabuk, Tabuk 71491, Saudi Arabia; (M.A.); (M.H.)
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McCorkindale AN, Patrick E, Duce JA, Guennewig B, Sutherland GT. The Key Factors Predicting Dementia in Individuals With Alzheimer’s Disease-Type Pathology. Front Aging Neurosci 2022; 14:831967. [PMID: 35557837 PMCID: PMC9085578 DOI: 10.3389/fnagi.2022.831967] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/23/2022] [Indexed: 12/26/2022] Open
Abstract
Dementia affects millions of individuals worldwide, yet there are no effective treatments. Alzheimer’s disease, the most common form of dementia, is characterized by amyloid and tau pathology with amyloid accumulation thought to precipitate tau pathology, neurodegeneration, and dementia. The Religious Orders Study and Memory and Aging Project (ROSMAP) cohort is a unique resource with quantitative pathology from multiple brain regions, RNA sequencing, and longitudinal cognitive data. Our previous work applying machine learning to the RNA sequencing data identified lactoferrin (LTF) as the gene most predictive of amyloid accumulation with a potential amyloidogenic mechanism identified in vitro and with cell-culture models. In the present study, we examined which pathologies and genes were related to cognitive status (dementia, mild impairment, and no cognitive impairment) and rate of cognitive decline. Tau load in the anterior cingulate and ADAMTS2, encoding a metallopeptidase, were the respective regional pathology and gene most associated with cognitive decline, while PRTN3, encoding a serine protease, was the key protective feature. ADAMTS2, but not PRTN3, was related to amyloid and tau load in the previous study while LTF was not related to cognitive decline here. These findings confirm a general relationship between tau pathology and dementia, show the specific importance of tau pathology in the anterior cingulate cortex and identify ADAMTS2 as a potential target for slowing cognitive decline.
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Affiliation(s)
- Andrew N. McCorkindale
- Charles Perkins Centre and School of Medical Sciences, Faculty of Health and Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Ellis Patrick
- School of Mathematics and Statistics, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - James A. Duce
- The ALBORADA Drug Discovery Institute, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom
| | - Boris Guennewig
- Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Greg T. Sutherland
- Charles Perkins Centre and School of Medical Sciences, Faculty of Health and Medicine, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Greg T. Sutherland,
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